Rotational range of motion of elliptical and spherical heads in shoulder arthroplasty: a dynamic biomechanical evaluation

Knut Beitzel,Lukas N. Muench,Elifho Obopilwe,Julian Mehl,Cameron Kia,Andreas B. Imhoff,Alexander Otto,Augustus D. Mazzocca,Mark P. Cote

doi:10.1007/s00402-020-03587-0

Abstract

IntroductionElliptical shape humeral head prostheses have been proposed to reflect a more anatomic shoulder replacement. Its effect on the rotational range of motion (ROM) compared to a standard spherical head is still not understood. The purpose was to investigate if there would be a difference in rotational ROM when comparing elliptical and spherical prosthetic heads in a dynamic shoulder model. The authors hypothesized that the use of elliptical heads would result in significantly more rotational ROM compared to the spherical head design.Materials and methodsSix fresh-frozen, cadaveric shoulders were evaluated using a dynamic shoulder model. After being tested in the native condition, each specimen underwent 6 conditions in the hemiarthroplasty state: (1) matched-fit spherical head, (2) oversized spherical head, (3) undersized spherical head, (4) matched-fit elliptical head, (5) oversized elliptical head, and (6) undersized elliptical head. Following conversion to total shoulder arthroplasty (TSA), the 6 prior conditions were rerun. Each condition was tested at 0°, 30° and 60° of glenohumeral abduction. Rotational ROM was quantified using 3-dimensional tracking, while dynamically applying alternating forces for internal and external rotation via the rotator cuff tendons.ResultsElliptical and spherical prosthetic heads showed no significant difference in the degree of the total, internal, and external rotational ROM for both the hemiarthroplasty and TSA state. Conversion from hemiarthroplasty to TSA resulted in less degree of total rotational ROM for both head designs in all abduction positions, without reaching statistical significance. There was a significant decrease in total, internal, and external rotational ROM for both elliptical and spherical heads in every replacement condition, when comparing 0° to 30° and 60° of abduction (P < 0.05, respectively).ConclusionIn a dynamic shoulder model, elliptical and spherical prosthetic head designs showed no significant difference in the degree of the total, internal, and external rotational ROM in both the hemiarthroplasty and TSA state.Level of evidenceControlled laboratory study

Highlights

Elliptical shape humeral head prostheses have been proposed to reflect a more anatomic shoulder replacement
Elliptical and spherical prosthetic heads showed no significant difference in the degree of total, internal, and external rotational range of motion (ROM) in both the hemiarthroplasty and total shoulder arthroplasty (TSA) state (P > 0.05, respectively) (Fig. 5a–c)
On average in the TSA state, 0° of abduction showed a greater ROM for the spherical head, while the 30° position favoured the elliptical head

Summary

Introduction

Elliptical shape humeral head prostheses have been proposed to reflect a more anatomic shoulder replacement. Results Elliptical and spherical prosthetic heads showed no significant difference in the degree of the total, internal, and external rotational ROM for both the hemiarthroplasty and TSA state. There was a significant decrease in total, internal, and external rotational ROM for both elliptical and spherical heads in every replacement condition, when comparing 0° to 30° and 60° of abduction (P < 0.05, respectively). Conclusion In a dynamic shoulder model, elliptical and spherical prosthetic head designs showed no significant difference in the degree of the total, internal, and external rotational ROM in both the hemiarthroplasty and TSA state. These humeral changes can cause further progression of this elliptical shape, especially in cases of severe disease [7, 22, 31]

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